Sunday, March 29, 2009

Looking Back....Rescue Services Get Some Criticism (Revised)

My comments are at the bottom.

Even though this article downplayed the situation, EMS was going to change for the better in Peoria. The Journal Star wasn't going to make it look like it had been too bad either.

And anyone that had read my Forum articles and posts carefully knew that I wanted the Peoria Fire Department to be able to help the citizens of Peoria and not be held back. I knew many of the AMT paramedics and relied on them greatly when they brought a patient to me in the Emergency Department. The paramedics were not at fault. Peoria's EMS leadership was the problem.

Peoria Journal Star
July 7, 2005


Rescue services get some criticism - EMTs, firefighters work well together, officials say

PEORIA - Criticism of the city's private ambulance service by a former emergency room physician is being downplayed but could still lead to discussion on how to improve the system.

Dr. John Carroll, who worked for 21 years at OSF Saint Francis Medical Center before he was fired in 2001, told the City Council on Tuesday of a recent incident in which a man at a Peoria restaurant went into full cardiac arrest and later died while a Peoria firefighter/paramedic on the scene wasn't allowed to try to help save him.

"Just think if that was your family member," Carroll told the council. "Valuable minutes really shouldn't be wasted at the scene" waiting for the city's ambulance service to arrive.

Carroll has been critical of Advanced Medical Transport, the city's only ambulance provider, since at least 2002, but some question whether his accusations are personally motivated by his firing.

"Dr. Carroll has been critical of our operations for some time now. I don't recall ever having the chance to speak with him personally," said Andrew Rand, AMT's executive director. "It's regrettable that these sort of anecdotal references are made that are unsubstantiated."

Rand noted that the AMT was recently given its second perfect score from the Commission on Accreditation of Ambulance Services, making it the only private provider in Illinois thus recognized.

"We have an excellent system," said Dr. Rick Miller, Emergency Medical Services Medical director. An employee of St. Francis, Miller has the responsibility of certifying people as paramedics and EMTs and overseeing their education. If there are any problems and someone has to be reprimanded, he is also involved.

"To say (firefighters) are standing around is inflammatory and an insult to the fire department," Miller added.

Firefighters can perform CPR, control a patient's airway, ventilate a patient, give oxygen and administer several medications. They can also use a defibrillator, which could be the most important tool for a cardiac patient, Miller said.

Those firefighters who are also system-certified paramedics can also use their skills to assist AMT paramedics if they request help - a relatively new change allowed by Miller.

It's also an example of what appears to be a sea change in the relationship between the fire department and AMT. Just a couple years ago, the fire department wanted to get into the ambulance transport business over AMT's objections. But now both sides say they are working together like never before.

"The last thing we want to do is go backwards in terms of the relationship between the fire department and AMT," said Tony Ardis, president of the firefighters' union.
Rand agreed.

"One of the important results of the city's emergency services study was to show the community and the policymakers the benefits of an organized emergency response system. (The study) was the catalyst for us to begin talking about things we never talked about before," Rand said. "We are talking constantly. The dialogue is weekly at various levels."

Indeed, Rand said it's likely both sides will talk about allowing firefighters who are already paramedics to do more, "but it's not because someone is beating me over the head."

Mayor Jim Ardis said he would like all sides to discuss ways to improve the system "as long as we differentiate the conversation and make sure it's clear we're not talking about transport.

"I think it would be a productive discussion to have, and I don't think it's getting into AMT's business," the mayor said. "I'm going to see if there's a feeling on the council as well as long as everyone understands that I don't see this as an effort to start up that whole transport war again."

My comments today--March 30, 2009. Here is what was really going on in the summer of 2005:

1. Dr Rick Miller was in charge of 80 EMS agencies (ambulance and rescues services) in the area. OSF appointed him to the job when Dr. Jim Hubler resigned from this position.

2. I was told in June, 2005 that Dr. Miller had reprimanded a Peoria Fire Department (PFD) firefighter and the firefighter was suspended from answering medical calls. The PFD firefighter had tried to secure an airway in an emergency by intubating the patient and that was apparently against the rules.

Apparently there were other airway issues with other patients in the weeks before I spoke to the Council. However, Dr. Miller was told that if the media found out about the suspension of the Peoria firefighter, after the firefighter had been trying to help the patient, that it would not be good for Dr. Miller and Peoria’s EMS.

3. As the Journal Star article above stated, I spoke to the City Council in early July and described the medical emergency that had happened in a Peoria restaruant.

4. I had spoken with the PFD paramedic who had taken care of this gentleman. The paramedic had told me that a man collapsed at a restaurant and 911 was called. The PFD arrived before AMT arrived and found the patient in full cardiac arrest. The PFD defibrillated the patient’s heart with successful return of a pulse. AMT arrived at the scene and attempted to intubate (place a breathing tube in the trachea) in the patient. When AMT was unsuccessful, they asked the PFD paramedic firefighter to intubate. Since he was not allowed to and his fire station captain was there to make sure that he did not intubate the patient, the PFD paramedic declined. Apparently, the AMT paramedics were able to intubate the patient successfully, but the patient died.

5. The Journal Star reported, “Those firefighters who are also system-certified paramedics can also use their skills to assist AMT paramedics if they request help - a relatively new change allowed by Miller.”

At some point after this terrible situation in the restaurant, Dr. Miller changed the rules. Dr. Miller was on the defense. Even though he was stating what an “excellent system” was in place, he was changing rules behind the scenes. The new rules stated that the PFD paramedics could intubate and give advanced life support drugs only if Advanced Medical Transport was on the scene AND asked for help from the PFD paramedics.

As a Basic unit, the PFD did not carry advanced medication, laryngoscopes, or tubes. So the new rules still had the patient waiting until AMT arrived to receive paramedic care.

6. In reality things had not been working great between the PFD, the Project Medical Director (Dr. Miller), and AMT as the Journal Star tried to convince the reader. There were a lot of politics involved behind the scenes. And there was a lot of money at stake if AMT lost their ability to be the sole transporter of pre hospital patients in Peoria.

7. After I spoke to the Council a committee was set up behind the scenes with the usual players involved in Peoria’s EMS placed on the committee. The Journal Star did not report this either.

8. Andrew Rand, Executive Director of Advanced Medical Transport, of course never denied that what I said occurred. And as I mentioned above, I always had respect for the AMT paramedics. It is the leadership in the Peoria Area EMS that is the problem.

9. The Journal Star reported, “Firefighters can perform CPR, control a patient's airway, ventilate a patient, give oxygen and administer several medications. They can also use a defibrillator, which could be the most important tool for a cardiac patient, Miller said.”

This is Basic-D care. Not advanced care. Controlling a patients airway and ventilating the patient is bagging them with a bag-valve-mask. The medications were medications that the patient could have had in their pockets. Dr. Miller made it sound like a lot, but it was not Intermediate or Paramedic care. The PFD paramedics were not allowed to function as independent paramedics for three more years in Dr. Miller’s “excellent system”.

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